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Trial registered on ANZCTR
Registration number
ACTRN12617000786392
Ethics application status
Approved
Date submitted
4/05/2017
Date registered
29/05/2017
Date last updated
29/05/2017
Type of registration
Retrospectively registered
Titles & IDs
Public title
The Effects of Neuromuscular Electrical Stimulation on Ankle Control and Gait Performance in Individuals with Chronic Stroke
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Scientific title
The Effects of Neuromuscular Electrical Stimulation on Ankle Control and Gait Performance in Individuals with Chronic Stroke: A Randomized Controlled Trial
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Secondary ID [1]
291849
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None
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Stroke
303098
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Condition category
Condition code
Physical Medicine / Rehabilitation
302557
302557
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0
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Physiotherapy
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Stroke
302558
302558
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0
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Haemorrhagic
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Stroke
302559
302559
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0
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Ischaemic
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Stroke individuals with inadequate ankle control were recruited and randomized to three groups: neuromuscular electrical stimulation on tibialis anterior muscle (NMES-TA), neuromuscular electrical stimulation on medial gastrocnemius muscle (NMES-MG), and control group.
Participants in both NMES groups received 20 minutes NMES on either tibialis anterior (NMES-TA) or gastrocnemius (NMES-MG) followed by 15 minutes of ambulation training 3 times per week for 7 weeks. The NMES was triggered by electromyographic biofeedback devices. The participants were asked to actively dorsiflex (NMES-TA) or plantarflex (NMES-GA group) to reach the training goal to activate the electrical stimulation. After participants completed 5 cycles of active ankle dorsiflexion or plantarflexion successfully, the training goal was increased by 2 uV progressively and lasted for 20 minutes.
Participants in control group received general exercises for 20 minutes, including stretching for 5 minutes and range of motion exercises for 15 minutes, followed by 15 minutes of ambulation training 3 times per week for 7 weeks.
The ambulation training was focused on ankle movement and ankle control. While the participant was walking, a physiotherapist provided verbal cues and immediate corrections when necessary to improve participant’s gait performance. All trainings were instructed by a physiotherapist with individual one-on-one sessions at the training center in National Yang Ming University.
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Intervention code [1]
297958
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Rehabilitation
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Intervention code [2]
297959
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Treatment: Other
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Intervention code [3]
298087
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Treatment: Devices
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Comparator / control treatment
Control group received general exercises for 20 minutes, including stretching for 5 minutes and range of motion exercises for 15 minutes, followed by 15 minutes of ambulation training 3 times per week for 7 weeks.
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Control group
Active
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Outcomes
Primary outcome [1]
301978
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ankle range of motion measured by twin-axis electronic goniometer at heel strike and push off during gait
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Assessment method [1]
301978
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Timepoint [1]
301978
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before intervention and after 7 weeks of intervention
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Primary outcome [2]
301980
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spatial-temporal parameters of gait obtained from the GAITRite system
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Assessment method [2]
301980
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Timepoint [2]
301980
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before intervention and after7 weeks of intervention
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Secondary outcome [1]
334429
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isometric muscle strength of ankle dorsiflexor and plantarflexor of the affected limb measured by handheld dynamometer
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Assessment method [1]
334429
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Timepoint [1]
334429
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before intervention and after 7 weeks of intervention
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Secondary outcome [2]
334430
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electromyographic (EMG) activities of ankle dorsiflexor and plantarflexor of the affected limb measured by bipolar Ag-AgCl electrodes during gait
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Assessment method [2]
334430
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Timepoint [2]
334430
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before intervention and after 7 weeks of intervention
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Secondary outcome [3]
334431
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Dynamic spasticity of ankle plantarflexors in stance phase during gait using the method proposed by Lamontagne et al. in 2001.
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Assessment method [3]
334431
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Timepoint [3]
334431
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before intervention and after 7 weeks of intervention
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Secondary outcome [4]
334432
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static spasticity of ankle plantarflexors measured by Modified Ashworth Scale in supine position
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Assessment method [4]
334432
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Timepoint [4]
334432
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before intervention and after 7 weeks of intervention
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Eligibility
Key inclusion criteria
The inclusion criteria were (1) first stroke at least 6 months ago, (2) with passive range of motion of ankle dorsiflexion at least to neural position (neutral position is defined as 0 degree), (3) with inadequate ankle control during gait (dorsiflexion less than -5 degree at heel strike and plantarflexion less than 10 degree at push off), (4) ability to walk at least 10 m with or without assistive devices, and (5) a detectable surface Electromyographic signal (>5 microvolt) from the TA and medial gastrocnemius (MG) of the affected leg
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Minimum age
20
Years
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Maximum age
80
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
The exclusion criteria were (1) sensory loss, (2) insufficient cognition (Mini-Mental State
Examination < 24) and communication function, (3) contraindications to Neuromuscular electrical stimulation such as a pacemaker and tumor, (4) other orthopedic and neurologic disorders affecting walking functions.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation is not concealed
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Permuted block randomisation
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people assessing the outcomes
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
The SPSS software (SPSS Inc., USA) was used for data analysis. The demographic and baseline data were compared among three groups using Kruskal-Wallis test. The Wilcoxon signed-rank test was used for within-group comparisons.
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Recruitment
Recruitment status
Stopped early
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Data analysis
Data collected is being analysed
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Reason for early stopping/withdrawal
Participant recruitment difficulties
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Date of first participant enrolment
Anticipated
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Actual
20/08/2013
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Date of last participant enrolment
Anticipated
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Actual
2/05/2014
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Date of last data collection
Anticipated
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Actual
24/06/2014
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Sample size
Target
45
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Accrual to date
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Final
25
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Recruitment outside Australia
Country [1]
8873
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Taiwan, Province Of China
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State/province [1]
8873
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Funding & Sponsors
Funding source category [1]
296347
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Government body
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Name [1]
296347
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Ministry of Science and Technology
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Address [1]
296347
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106, Sec. 2, Heping E. Rd., Taipei 10622, Taiwan, R.O.C
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Country [1]
296347
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Taiwan, Province Of China
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Primary sponsor type
University
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Name
National Yang-Ming University
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Address
No. 155, Li-Nong Street Section 2, Pei-Tou District, Taipei, Taiwan 112
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Country
Taiwan, Province Of China
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Secondary sponsor category [1]
295298
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None
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Name [1]
295298
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Address [1]
295298
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Country [1]
295298
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
297579
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Taipei Veterans General Hospital
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Ethics committee address [1]
297579
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No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, Taiwan 11217
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Ethics committee country [1]
297579
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Taiwan, Province Of China
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Date submitted for ethics approval [1]
297579
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Approval date [1]
297579
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19/07/2013
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Ethics approval number [1]
297579
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2013-07-028B
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Summary
Brief summary
Walking dysfunction is a major problem leading to physical disability even after rehabilitation in stoke. Decreased gait speed and asymmetric gait pattern are common gait deficits resulted from spasticity, muscle weakness and poor motor control, especially in ankle joint. There are many strategies focused on the improvement of ankle control in the stroke rehabilitation. Neuromuscular electrical stimulation (NMES) is one possible treatment strategy, which is commonly used in clinic. Previous studies suggested that NMES not only improved muscle strength but also decreased static spasticity through reciprocal inhibition. However, controversial results are noted in these studies. Besides, the static measurement of ankle plantarflexors spasticity may not explain the spasticity in the dynamic status during gait. Furthermore, the effects of NMES on gait symmetry were not established. The purpose of this study was to investigate the effects of NMES applied to ankle dorsiflexors or plantarflexors on ankle control and gait performance in individuals with chronic stroke. Twenty-five stroke subjects with inadequate ankle control were recruited and randomized to the NMES-tibialis anterior (NMES-TA, N=8), NMES-medial gastrocnemius (NMES-MG, N=9) and control group (N=8). Participants in NMES groups received 20 minutes NMES on either tibialis anterior or gastrocnemius followed by 15 minutes of ambulation training 3 times per week for 7 weeks. Participants in control group received 20 minutes of range of motions (ROM) and stretching exercises followed by 15 minutes of ambulation training 3 times per week for 7 weeks. The outcomes included ankle control, muscles strength of dorsiflexors and plantarflexors, spasticity of plantarflexors, EMG activities during walking and gait performance. All assessments were administered at baseline (pre) and after training (post).
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Trial website
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Trial related presentations / publications
None
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Public notes
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Contacts
Principal investigator
Name
74502
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Prof Ray-Yau Wang
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Address
74502
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Department of Physical Therapy and Assistive Technology, National Yang-Ming University, 112. No. 155, Sec 2, Li Nong St., Shih-Pai, Taipei, Taiwan
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Country
74502
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Taiwan, Province Of China
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Phone
74502
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+886228267210
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Fax
74502
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Email
74502
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[email protected]
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Contact person for public queries
Name
74503
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Ray-Yau Wang
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Address
74503
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Department of Physical Therapy and Assistive Technology, National Yang-Ming University, 112. No. 155, Sec 2, Li Nong St., Shih-Pai, Taipei, Taiwan
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Country
74503
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Taiwan, Province Of China
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Phone
74503
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+886228267210
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Fax
74503
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Email
74503
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[email protected]
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Contact person for scientific queries
Name
74504
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Ray-Yau Wang
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Address
74504
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Department of Physical Therapy and Assistive Technology, National Yang-Ming University
112. No. 155, Sec 2, Li Nong St., Shih-Pai, Taipei, Taiwan
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Country
74504
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Taiwan, Province Of China
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Phone
74504
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+886228267210
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Fax
74504
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Email
74504
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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